There is No Sunken Treasure

My time at the VA has come to an end, but it was filled with memorable patients. The list includes:

1. A flamboyantly gay patient with a bowel obstruction who hit on me daily and had a friend who visited in a mesh shirt and short shorts

2. A patient with colon cancer who ruined his false teeth while chewing through his protective mittens and confused his wife with a woman of ill-repute while suffering from delirium postoperatively

3. A female patient with a horrible gallbladder and an abdominal wall littered with tattoes that we had to negotiate (her rose now has a thorn)

4. An incredibly nice patient with stomach cancer who had incurable disease as is often the case with nice people

5. A talkative patient with colon cancer who went on and on about the 13 sisters he “had to get the hell away from” by travelling around the world with the Army

6. A deaf, slow groundskeeper with a buttock tumor whose treatment could only be discussed through an intermediary…”could you tell your employee that he needs to come to the VA for his butt surgery?”

7. A patient with hemorrhoids who came to surgery with his teddy-bear and South Park pajamas

It was a great experience and I will be looking forward to returning during my last year of residency.

In a city saturated with restaurants, it’s hard to be original. I just went to the relative new-comer Aigre Doux, and they did a very capable job with the whole Contemporary American concept. The restaurant is located in the hulking shadow of the Merchandise Mart. The space is clean and simple, and the service, at least ours, was quirky but friendly. I had the tuna carpaccio to start which was good, the table shared a black truffle pizza which was very good, my main course was a tasty slow-baked salmon with a citrus emulsion, and I ended with a cheesecake which was just alright. I enjoyed the experience, but I think they might have a hard go at it with River North staples such as Crofton on Wells so nearby.

My chief resident is on vacation this week, making me the default senior resident on the VA general surgery service. It has actually been a lot of fun, although it has also been a little nerve-racking to be in charge of doing the operations (with some help from the attendings, of course). So far I’ve taken out one colon cancer laparoscopically, a massive buttock angioleiomyoma, a thigh sarcoma, and a rectal cancer. To my surprise and relief the first guy does not have an anastomotic leak, the second guy is not incontinent, the third guy can still walk, and the fourth guy can still sit on the toilet. I’ll feel completely at ease, however, only when they are all at home watching the Olympics from the comfort of their recliners.

Throughout my life I have watched nature shows. As a preteen I was a huge fan of Shark Week, and I continue to see my fair share of in-the-excitement-of-the water-hole’s-discovery,-the-gazelles-forget-that-danger-lies-beneath-the-calm-waters shows. These viewing experiences have helped shape my geopolitical world-view. For example, I know that Africa and South America are places with wild, untouched interiors surrounded by oppressive dictatorships or failed democracies which are, in turn, surrounded by shark-infested waters.

This past week I finally purchased a large LCD TV, and immediately rented Planet Earth to break it in. This BBC program is similar to, and yet unlike, other nature programs. It still has the old-fashioned predator/prey drama, but this is enveloped into a much large story explaining how the Earth’s geography and climate determines the very conditions under which this drama unfolds. No longer are we as viewers amazed that the elephants were able to find that watering hole in the middle of the Sahara. Instead, we watch as animals of all types converge on a flood plain which predictably forms as a result of the Earth’s weather patterns. We watch as animals of all types rush to the poles during the winter to feast on the abundant algae brought into being by means of the Sun’s nourishing rays. Its ability to tell this bigger story is helped not only by its impressive range of footage but also in its reliance on video captured from above. Rather than trailing wild dogs from a jeep, the film-crew obtains a panoramic view of the hunt with a high-resolution camera mounted to a helicopter.

The ebb and flow of life as revealed in Planet Earth is truly amazing. It rekindled my excitement in the evolutionary process that began during the 7th grade as I read the biography of Charles Darwin. I did not stay in my dark basement watching the series for too long, however, as I had to be true to my own seasonal patterns. Unlike other animals who gorge themselves in summer to prepare for the harsh winter, I had to be active in the Sun to prepare for my long winter months of hearty soups, gamey meats, and oatmeal stouts.

The Dark Knight has been a critical and box-office success, and all sorts of praise has been heaped on Heath Ledger’s performance. I had already built-up the movie in my mind and was quite giddy with anticipation, so all the post-release buzz just worked me into a frenzy. I went to see the movie as soon as I could, and came close to seeing it on IMAX (which I have never done before). No movie could live up to these expectations, but The Dark Knight did come pretty close. In particular, I thought Nolen’s ability to expound on his Batman as legend (or symbol) motif started in Batman Begins was masterful.

In the original Batman, the Joker and Batman were drawn together by their psychological scars. The Joker killed Batman’s parents and Batman is responsible for the Joker’s deformity. Each is responsible for the other’s existence and the relationship gains significance as a result. In The Dark Knight, the Joker provides narratives regarding his physical and spiritual scars in the same vein as above, but only to  scoff at the whole of modern psychology. Instead of psychological, the Joker and the Batman pairing has sociological significance. Take note that the caped-crusader is referred to as the Batman, rather than Batman; he is a symbol rather than an individual in Nolen’s hands. The Joker is the symbol par excellence, adhering to a strict code of chaos. His horrific actions serve to demonstrate the weaknesses in human civilization that already exist rather than to create them through force of will. He is not proving a point but only to demonstrating a fact. Batman, on the other hand, adheres to a strict code of morality which is too severe for civilization as a whole but represents an ideal. His hope is that an ideal hero could both uphold these principles and “have a face”, and he places this hope in Harvey Dent. It turns out to be misplaced as Dent is transformed into Two-Face and the individual and the symbol fail to congeal into a whole. What remains are two opposite symbols terrorizing and saving the city of Gotham simultaneously. One attempting to prove individuals are slaves to the base instincts and the other attempting to prove that individuals, however flawed, can do right. This individual thoroughly enjoyed the struggle.

Last week we had an interesting but sad case at the VA involving a sixty year old veteran with metastatic rectal cancer. He never had his primary tumor taken out, but had undergone chemotherapy. The tumor had eroded into his bladder, creating a passage, or fistula, from his rectum. He came into the hospital because this problem presented itself in a rather intolerable manner. We relieved this state of affairs by bringing an upstream loop of colon to the skin and opening it. This is called a colostomy. The surgery was palliative rather than curative, but it hopefully will improve his quality of life.

This week the Chief of Surgery at the VA cleared out an old library and asked us if we would like any of the texts for our office or for ourselves. We took a bunch of books for the office, but I kept one book entitled the Atlas of Intestinal Stomas for myself. It was published in 1967 and describes the history  of surgical ostomies accompanied by illustrations. According to the text, the Frenchmen Dr. Duret performed the first colostomy on a three-day-old infant in 1793. For this accomplishment subsequent surgeons have given him the distinguished title of Father of Colostomy. Given the recent case and the fact that my third year of residency involves four months of colorectal surgery, I thought this would be a useful book to have in my personal library. I doubt it will be displayed on the coffee-table, but it should make great bathroom reading.

I just finished two months on Pediatric Surgery where I worked at least eighty hours per week. Prior to that I was on my Nightfloat rotation, which involved working 6pm to 6am six days a week in the ICU. These rotations were not particularly good for my homelife as there were literally days on end when I did not see my wife. I left Pediatric Surgery with one last kick in the nuts as they scheduled me for a twenty-four hour call on my last day. This meant I was able to start my rotation at the VA hospital with three hours of sleep the previous night. The VA is a relatively easy rotation, mostly because it is next to impossible to do anything quickly there. Still, this past week was busy by VA standards and did involve a twenty-four hour call. Thursday evening I got home at 8:30pm, exhausted.

Friday I had a day off, so we decided to take advantage of the opportunity. We packed some Coronas, towels, and our iPods and went to a beach along Lake Michigan. We talked, sipped our beers, and got just the right amount of sunburn. Afterwards we went to a restaurant in Lincoln Square called Chalkboard. The food was just what we had hoped for, fresh and summery. We started with some sparkling wine and nibbled on a king crab salad and seared tuna. I ordered the fried-chicken with fresh collard greens, mashed potatoes and white sausage gravy while my wife ordered the wild Alaskan halibut with spring ramps, asparagus, and moral mushrooms. I am definitely not a fried-chicken person, but the waitress recommended it as the chef’s specialty so I gave it a try. It was quite good and nearly boneless. After dinner we watched the neighborhood punks’ fireworks display from the comfort of our bed.

Now after this twenty-four hour respite, I am back in the hospital doing another twenty-four hour call. Neither the veterans in the hospital nor I are independent today.

Growing up, drive-in movies were almost a thing of the past. My family did drive to one of the remaining Chicagoland theaters a couple of times. Us kids would play on the run-down playground, walk around the gravel parking lot, and then lay in the back of the family conversion van watching movies like Who Framed Roger Rabbit and Batman. By the time I was old enough for petting and necking, however, there weren’t any drive-in theaters at which to do so (although there was the conversion van). As a result, my memories of the outdoor movie experience has remained blissfully child-like.

The Chicago Park District gave me an opportunity to recapture this childhood pleasure with its Movies in the Parks program. While running the other day, I passed a flyer advertising a showing of The Golden Compassat Holstein Park. This particular park is very neighborhoody with a small baseball field and rows of surrounding two-flats. I could just imagine myself on the cool grass eating popcorn in the twilight, so I dragged my very indulgent wife there. We sat on a blanket, drank some wine, and watched the mediocre movie. The cheerful chattering of children before the show, the dialogue of the movie breaking the otherwise quiet summer night, and the pleasant walk home under the street-lamps made the experience exactly what I had desired. And I didn’t even suck face.

I have always espoused the incorrect position that children are merely little adults. I know the whole of pediatrics and childhood development refutes this belief, but I get a kick out of repeating this to those who care for the young. While working at the children’s hospital for the last two months, however, I have finally learned that children are actually an entirely different manner of being called Kiddos. Every consultation I receive from the ER or the pediatric medicine service invariably begins with the phrase “I have this kiddo I would like you to see…”. These kiddos come in various shapes and sizes; some are FLKs, some are whimpering toddlers with Leukemia, some are your average inner-city kid, and some are young adults with chronic illnesses who have not graduated from pediatric care.

The pediatric surgery service is involved in the care of all these kiddos. We fix congenital defects in the FLKs, put in ports and do biopsies on the cancer kiddos, take out the (more often than not ruptured) appendix for the cute Black or Hispanic kiddos, and hold other kiddos hostage in the hospital for months while we try to “fix” their social comorbidities. We are called to evaluate all kiddos in the ER who have complained of abdominal pain within the previous year or have fallen off their bike two days ago and now have a headache. The motto of the hospital is Where Kids Come First and there is no doubt that the nursing staff and physicians caring for them smother them with every sort of attention.

In order to be a pediatric surgeon you must have an exquisitely tight sphincter, complete about twenty years of post-graduate training, and have the irrepressible urge to stroke and speak in a baby-voice to every child you come in contact with. Needless to say, I will not be a pediatric surgeon. My mother always told me I was good with kids and that I would make a great pediatrician. I am not saying this is untrue, but I am fundamentally incapable of adopting the attitude that pervades the hospital. I will on occasion pet a kiddo for reassurance, but I tend to talk to them as if they were little adults. This approach does not work with a 2 year old who needs a chest tube removed. No matter how rationally you explain your position, they just scream and clutch their mother. Surgeons do things to patients that would be considered torture if improving the patient’s health were not the objective, but most children do not understand this subtlety.

I’ve been on this rotation for nearly two months and I am looking forward to my coming months at the VA. No longer will I have to take overnight call every third night, scrape the bottom of the barrel to do a case (somehow I&Ds are ”fellow-level”), or hear that recurrent and irritating phrase over the phone. The Vets may not be as cuddly as the kiddos and when they poop in their diaper it is not cute, but they can be reasoned with and their response tends to be “Okay Doc” rather than shrill screams.

 It took me a while to see There Will Be Blood, mostly because my wife adamantly refused. Well, I finally watched it the other night, and enjoyed it for reasons different than I expected. I thought the film would be plot-driven, with interpersonal conflicts propelling it forward. Instead the movie is a parable that gathers its energy and meaning from a single character, Daniel Planview. I also expected scenes of explicit violence similar to No Country For Old Men, yet nearly all of the violence was contained in verbal exchanges (except when that one guy was shot in the head or that other guy was beaten to death with a bowling pin).

Let me add my voice to the chorus praising Daniel Day-Lewis’ ability to inhabit a role. I thought his role in The Gangs of New Yorkwas over-the-top, but his Daniel Planview was believable in his all-consuming egotism. The other characters in the movie are mere foils to better illustrate Planview’s nature. The preacher’s feigned faith and fervor stand in contra-distinction to Planview’s absolute lack of faith in Mankind and his inner fury. Planview’s reaction to his injured son demonstrates his inability to tolerate perceived weakness in others and himself. His impulsive outbursts at Standard Oil’s representatives reveals his drive to thrust himself above others in spite of and because of their belief that he is incapable of doing so.

In the end, Planview is a brutal man bent on success in order to humiliate others and distance himself from them. He drills for oil to snatch the lifeblood of others from under their own barren soil. His accomplishments culminate in him buying a large, empty house where he can drink whiskey alone. Having accomplished so much by turning his destructive nature outward, his reward is to turn that nature onto itself and destroy himself as he sees fit. Paul Thomas Anderson does an excellent job handling Daniel Day-Lewis and shapes the bleak Texas landscape into a fitting backdrop for his parable of Man’s Will to Power. Of note, the soundtrack by Jonny Greenwood, of Radiohead fame, is a perfect mix of Copland, Ives, and Bartok; bringing just the right amount of poetry and silence to this dark movie.